Despite repeated claims from Russian and pro-Russian Chechen officials that the situation in Chechnya is normalising, the conflict and related human rights abuses continue.1 The decade of conflict has resulted in an estimated 260 000 internally displaced people. By mid 2004, around 52000 remained in the neighbouring Republic of Ingushetia. Most live in places unfit for human habitation--tent camps or spontaneous settlements such as train wagons, abandoned farms, factories, and warehouses.

Since September, 2003, the Russian and Ingush authorities have been putting considerable pressure on internally displaced people in Ingushetia to return to within Chechnya's border. Health systems and other public services in Chechnya are in a dire state, and a lack of security in the region means that aid agencies are severely restricted in their ability to move around the region to provide additional support.

Earlier this year, Médecins Sans Frontières (MSF) undertook quantitative health surveys2 in the displaced populations both in the spontaneous settlements in Ingushetia and temporary accommodation centres on the Chechen side to obtain information on displacement history, living conditions, and psychosocial and general health status. Results show that insecurity and substandard living conditions prevail in both camps. Most people in the settlements and temporary accommodation centres have been displaced in two waves, either in 1994 or 1999, during periods of severe conflict in Chechnya, and have since been forced to relocate several times. Interviewees said they were prevented from returning home because of security fears or because their property had been destroyed.

Almost all people interviewed had been exposed to crossfire, aerial bombardments, and mortar fire. More than one in five had seen killings, and nearly half had seen maltreatment of family. About 90% of people in the Chechen camps and 80% in Ingushetia had had someone close to them die as a result of the war-related violence. Ongoing conflict in Chechnya continues to disrupt people's lives. Over a third of people in Ingushetia felt unsafe, while in Chechnya two-thirds expressed concern about their security. 7% of people in Chechnya and 9% in Ingushetia reported that a family member had died in the 2 months before survey, many as a result of violence. The arrest or disappearance of friends or neighbours was common on both sides of the border.

The health effects of these experiences continue to take their toll. However, access to medicines and health services is problematic in both locations. Non-specific health complaints, such as headaches and joint pains, are common within these populations--a finding consistent with high levels of mental stress. Over two-thirds (80% in Chechnya; 67% in Ingushetia) of respondents said the conflict had triggered mental disturbance.

Overall, living conditions for the internally displaced populations are clearly inadequate in both Ingushetia and Chechnya. The population cannot protect itself against the bitter weather, sanitation is poor, and food insecurity is a problem in both republics. Health issues, including mental health complaints, are common, but services are poor. Many people (one in three in Ingushetia, twice as many in Chechnya) live in constant fear. Such miserable conditions have persisted for years and the results of our survey show that they are ongoing.

The current policy of moving people, against their will, from one inadequate and insecure location to another will only worsen the plight of this vulnerable population. The Russian authorities must guarantee a safe environment, ensure protection of civilians, as well as acceptable living conditions and health services for this displaced population. The international community should pay greater attention to this conflict, which has been largely ignored for the past decade.